This study identified a few key facilitators of community coalition sustainability and coalition building. First, findings suggest that leadership is one of the key facilitators of community coalition sustainability. Policy makers may consider investing in local leaders and building leadership capacity in communities across the country through technical assistance and training opportunities. The most effective and highly sustainable coalitions were led by leaders with prior experience working within their community, suggesting that leadership training in community-based participatory approaches may be valuable. Policy makers should also consider investing in other mechanisms for supporting sustainability, such as funding rigorous data collection and evaluation to encourage results-oriented planning and assist coalitions in appealing to additional funders.
Findings from this study demonstrate that even ten years after HCAP began, many sustained and not sustained coalitions are still investing in capacity building and developing their networks and partnerships. Even sustained coalitions that have been operating at a particularly high level and are achieving important systems and policy level changes, still find that they need to invest resources into maintaining and nurturing their networks and partnerships. While capacity building activities may wane over time, policy makers should structure funding to account for an ongoing investment in these activities throughout the life of the coalition.
Additionally, this study provides guidance to policy makers as they invest in new demonstration programs in support of the Affordable Care Act. First, policy makers may use the findings from this study to develop standards for sustainability planning. Currently, many federal programs require community coalition grantees to develop a sustainability plan post-award. However, other programs do not require grantees to document their sustainability plans at the outset. Given that this study suggests the importance of preparing for sustainability through concrete action steps (rather than just plans), policy makers may be interested in developing tools that provide guidance about the specific actions coalitions can take to sustain themselves. This may be particularly important given that this study found that developing a sustainability plan at the outset is not enough.
Additionally, in developing future programs, policy makers should consider supporting core coalition operations to increase the likelihood of long-term sustainability. Many of the former HCAP coalitions have been able to continue to deliver programming over time because they had funding for core operations as well as programming purposes. Further, the coalitions that thrived post-funding were able to continuously support at least a few FTEs to manage and convene the coalition; these coalitions asserted that their sustainability would not have been possible in the absence of operations funding. In a down economy, federal funding for core coalition operations may enable coalitions to sustain themselves until it is possible to secure new funds.
Finally, policy makers may provide differing amounts of funding for differing amounts of time depending upon the coalition’s particular situation—for example, by making smaller, shorter duration grants available to highly effective and sustainable coalitions that have a history of programming. Such funding opportunities will help coalitions to build resiliency in difficult times (e.g., to weather an economic downturn or the loss of a key funding partner) without detracting from their momentum in the community.